Use of Proton Pump Inhibitors Increases the Number of Episodes of Inflammatory Bowel Disease

Objective: Proton pump inhibitors may alter intestinal microbiota, and changes in intestinal microbiota may lead to the activation of inflammatory bowel disease. In our study, we investigated the association between proton pump inhibitor use and inflammatory bowel disease activation. Methods: A total of 67 inflammatory bowel disease patients were enrolled in this study. The number of inflammatory bowel disease episodes, medications used, and the use of proton pump inhibitors were evaluated retrospectively for all patients. We divided the patients into 2 groups as proton pump inhibitor users and non-proton pump inhibitor users, and the groups were compared. Results: The median age of the 67 inflammatory bowel disease patients (41 male and 26 female) was 37 (18-70) years. The disease duration since diagnosis was 63.4 (10.2-223.6) months, and the total number of episodes was 3.0 (0-20). Crohn’s disease was diagnosed in 23 patients (34.3%) and ulcerative colitis in 44 (65.7%) patients. Of the patients, 35 (52.2%) were on anti-tumor necrosis factor treatment and 41 (61.2%) had proton pump inhibitor usage history for a median of 40 (1-300) months. Among 41 proton pump inhibitor users, 34 (82.9%) had a history of inflammatory bowel disease activation during the course of treatment. When proton pump inhibitor users and non-proton pump inhibitor users were compared in terms of disease duration, there was no difference ( P = .65); however, the number of inflammatory bowel disease episodes was significantly different (5.0 (0-20) episodes vs. 1.5 (0-17) episodes, respectively; P < .0001). Conclusion: In patients with inflammatory bowel disease, proton pump inhibitor use may be associated with an increase in the incidence of disease episodes. Randomized, controlled studies involving more patients will guide to clarify the uncertain points of this finding.